Background: Patients with atopic dermatitis (AD) often have increased skin sensitivity and this symptom often worsens during stress.
Objective: We sought to find out whether patients with AD had stinging, and to identify the pathocausal neuroimmune mechanisms, including the role of stress.
Methods: In all, 25 patients with AD with histories of stress worsening were tested using a stinger test. Skin biopsy specimens were processed for immunohistochemistry. Stress inquiries and salivary cortisol tests were performed.
Results: In all, 16 patients were stinger-positive and 9 were negative. The stinger-positive papillary dermis had an increased number of mast cells, vasoactive intestinal polypeptide-positive fibers, and a tendency to a higher number of substance P-positive nerve fibers, but a decrease of calcitonin gene-related peptide fibers. Patients who were stinger-positive had a tendency to lower salivary cortisol.
Conclusions: The majority of patients with AD experience stinging. Substance P, calcitonin gene-related peptide, vasoactive intestinal polypeptide, and mast cells may have a pathocausal role, as might chronic stress.